| NPI | 1366960361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801107398) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 99081384A) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34008658A) | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2022-07-21 |